Death and Disease in Ancient Rome

Linda Gigante
Associate Professor of History
University of Louisville

           When we think of ancient Rome, we imagine an imperial capital with impressive marble structures and luxurious dwellings. Indeed, at the height of the empire (around 150 CE) Rome was the largest city in the Mediterranean, with a population estimated at one million. Its metropolitan center was filled with awe-inspiring buildings, which proclaimed the power and glory of the Empire: her Coliseum, the Roman Forum, public bathes, and the monumental markets built by the emperor Trajan. Rome’s wealthiest residents lived in richly appointed homes located in the finest neighborhoods and commanding impressive views of the Tiber located in the finest neighborhoods an commanding impressive views of the Timber River. What we tend not to consider is the fact that this privileged life-style was enjoyed by only about 5% of robe’s population, with the remaining 95% living at or below the poverty level.

Roman society was rigidly stratified, with slaves and freed slaves at the bottom of the social hierarchy. It is impossible to det3ermine the number of slaves and urban poor living in Rome at any given time, but it must have been enormous. For these residents, live was anything but luxurious. Their neighborhoods were cramped, squalid, and dangerous. Instead of single-family dwellings (domus), the urban poor lived in high-rise (3-5 story) apartment buildings (insulae), which were, at best, equipped with communal latrines and water-fountains. It is estimated that in the early Empire apartment buildings in Rome outnumbered single-family dwellings by a ratio of 26:1. Because of overcrowding, poor sanitation, and generally poor nutrition, diseases were rampant among Rome’s urban masses whose life span was, consequently, very short.

My goal this evening is to reconstruct for you a picture of the equality of life of working-class Romans at the height of the Empire (between 100 and 200 CE). I will briefly discuss diet, general health and life expectancy, as well as the various diseases to which the general population apparently succumbed. I will also consider the burial rituals practiced by the Romans and the funerary monuments which they provided for their loved ones. By way of conclusion, I will discuss the Roman funerary monuments in the Speed Museum and explain the research project, which is currently underway to publish them.


The diet of an average Roman consisted of cereals, olives, wine, as well as fruits and legumes like chickpeas and lentils. Fish was a luxury and rarely eaten, and the primary source of met came from pigs. Cereals in the forms of bread and the porridge were a staple of a Roman’s diet, as the monthly state distribution of free grain to the urban poor attests. The poor, mothers and young ch8ldren were probably undernourished and, because the babies of well to do mothers were n9rmally given to wet-nurses and, hence, denied colostrums, they were particularly venerable. Food was transported into the city on wagons from suburban farms an market-gardens an on barges form Rome’s port-city of Ostia; it was then distributed to markets throughout the city. For example, the Cattle Market (Forum Boarium) was located at the foot of the Capitoline Hill and near the Tiber River. Since the cleanliness of these urban markets much has been marginal at best, there is to doubt that food contamination was a major problem, making intestinal parasites a common malady. For example because of its proximity to the Tiber, the Cattle market was routinely flooded and, there fore, food was most likely contaminated on a fairly regular basis.


While the public sewers in Rome were maintained by the state, private drains were the responsibility of the property owner and, hence, usually neglected. In fact, very few dwellings in the imperial capital were directly connected to either street drains or the public water supply. Kitchens were normally located near the households’ latrines, which were little more than cesspits, which had to be cleaned out by hand. An apartment building may have had a latrine and fountain on the found floor for its many residents. It was customary for those living in apartments on the upper floors, Rather than using the latrine on the ground floor, to empty their chamber pots out their apartment windows. Since there was no official street cleaning service in Rome, the congested neighborhoods were malodorous and plagued with files and dogs, which spread diseases.

Aqueducts channeled thousands of gallons of fresh water into Rome each day, supplying hundreds of public water-basins and bathing establishments throughout the city. For a nominal fee averaged Romans could refresh himself or herself at a large imperial bath building (thermae) –like the Baths of Caracalla_ or a small privately owned neighborhood establishment (balnea). The Romans associated the baths with hygiene and health, for statues of Asclepius (the god of healing) and his daughter Hygeia (Good Health) were a popular form of decoration in the baths. Spending time at the baths was an integral part of a Roman’s daily ritual, with women visiting the baths in the morning and men in the afternoon. What is not commonly known is that the sick and the healthy often bathed together, for doctors regularly recommended that their patients visit the baths for their therapeutic value. The ill apparently preferred to visit the baths at midday or at night when the general public did not frequent them. The Romans did not have disinfectant and, while the evidence is scanty, it is likely that the bathing pools (which did not have circulating water) were only periodically emptied and cleaned. The picture that emerges, and then is that roman baths were not the pristine, hygienic places that we imagine them to have been.

It was customary for a latrine either to be incorporated into a public bath building or to be adjacent to one. On average, public latrine (forica) could accommodate between 10 and 20 people at a time, affording no privacy to its patrons. Water running through a channel beneath the seats removed the waste, and toilet sponges were available for the patrons’ use; these reusable sponges were a breeding-ground for bacteria.


While the people of Rome are known to have suffered from plagues, which erupted at various times, the real killers, were infectious diseases like malaria (Plasmodium Falciparium, the most dangerous form), tuberculosis, typhoid fever, and certain digestive ailments like gastroenteritis. Studies suggest that the period from July to October was marked by high mortality, with about 30,000 residents dying each year. Roman authors refer to these months as ‘sickly’ and urge their fellow Romans to flee the city for the healthy climate of the country. Comparatively speaking, there was low mortality form November to February, except for the elderly who were particularly venerable to diseases during the winter months. The most deadly diseases to which Rome’s population routinely succumbed were affected by temperature; in particular, the most lethal form of malaria, which had long incubation period and high temperature requirement, did not reach its peak frequency until autumn. The high death rate from July to October could also have been due to other diseases (like tuberculosis and typhoid) which were rendered lethal form a general weakness of the body due to previo7s malarial attacks. It is estimated that each year several thousand people died in Rome form these diseases, with women and young children aged 1 to 5 especially vulnerable. Given the close quarters in which the urban poor lived, their poor hygiene and undernourishment, as well as the constant influx into the city of migrants who were incapable of fighting these diseases, it is no wonder that infectious diseases were virulent killers.

Death and Burial:

The evidence suggests that there was no distinction in mortality –rates between men and women, but it is likely that in epidemics women under the age of 40 experienced higher mortality than men. This would have been due to women’s harder work regimes and poorer diets than those of their male counterparts, as well as the dangers associated with childbirth. On average, the life expectancy at birth of women was between 20 and 30 years and that of men a bit higher. Of course, slaves must have had a shorter life expectancy, probably not living much beyond 20 years. While there are no precise figures regarding infant mortality, it appears that children in the first 10 years of life ran a very high risk of death. It is estimated that more than 50 % of all children in this age group suffered from malarial infection. The picture emerges, than is that children in Rome frequently predeceased their parents and wives died years before their husbands.

Virtually all burials took place outside Rome’s city-limits, a custom that must have derived from concerns about the health of the urban environment and age-old taboos. In fact, along the major highways leading into and out of the city (like the via Appia) there were cemeteries, with the tombs of Rome’s wealthiest families the most prominent. In contrast, the bodies of the poorest Romans were anonymously buried in large, open public pits (puticuli), like those outside the Esquiline Gate. While the Romans practiced cremation and inhumation simultaneously, cremation burial was the preferred method and crematories were safely situated in the periphery of the city, adjacent to the cemeteries.

It was the duty of a Roman family (the heir, in particular) to make the funeral arrangements fro a loved one. The ceremony of the funeral and the size of the tomb reflected the family’s social stature and financial resources. For example, hiring a large number of female mourners (praeficae) to attend the lying in state in the home (collocatio) and to walk in the procession to the tomb (exsequiae) was a clear sign of a family’s prominence. At the other end of the social spectrum were the slaves and the urban poor where often dumped like rubbish in the outskirts of town and transported to the communal burial-pits by public undertakers (libitinarii). According to the Romans’ sensibility, anonymity in death was the worst fate, for it was remembrance of the deceased (memoria), which secured immortality.

For the vast majority of Rome’s population, that is, for the families of freed slaves and for slaves provided for by their masters, there was cremation burial in communal tomb  (columbarium) outside the city limits. A columbarium was normally a subterranean structure in whose walls were carved rows of niches for ash-urns (cinerariaa). Beneath each burial niche a stone epitaph identifying the deceased was nailed to the wall. Ancient sources indicate that the most expensive burial niches were those at or near ground level and the cheapest were those, which were least accessible… and the least visible to visitors. Family members routinely visited the columbarium to bring flowers and gifts (like lamps and vessels with food and libation) to honor the memory of their loved one. Over the years many columbaria have been discovered outside the walls of Rome and emptied of their contents, most often without careful documentation. Nevertheless, the ash-urns, grave-goods and epitaphs removed from these tombs have provided archaeologists and historians with valuable information about Roman burial customs and the non-elites of roman society.

The Ballard-Thurston Collection:

One of the most important collections of non-elite funerary monuments taken form columbaria in Rome was donated to the Speed Museum in 1929 y Rogers Clark Ballard-Thurston of Louisville. In December 1911 he, along with his brother, sister in law and friend, traveled to Italy in order to purchase antiquities. While in Rome, they made the acquaintance of and Italian agent who took the Louisvillians to the newly completed Carmelite Church and monastery of Santa Teresa in the northern region of the city, near the ancient via Salaria. Ballard Thurston purchased hundreds of funerary artifacts (ash-urns, offering vessels, lamps and epitaphs) removed from columbaria, which were discovered at the site in the late 1890’s, at the time of the church’s construction. Twenty-eight crates of roman antiquities were sipped to New York in February 1912 and transported by rail to Louisville, where they arrived two months later. Following Ballard-Thurston’s donation of his collection to the Speed in 1929, a few objects were displayed, with small exhibitions mounted in 1932 and 1940. While some pieces were exhibited in the Speed’s antiquities gallery over the years, most of them remained in their original shipping crates for more than five decades.

In 1985, when the Speed was being remodeled and an addition was being built, I was notified that in a corner of the min buildings basement there were more than 20 wooden crates containing antiquities. The crates were moved to the attic of the museum and, with the assistance of U of L students, they were emptied of their contents. We found more than 60 terracotta ash-urns (ollae) with assorted lids; 70 intact and fragmentary terracotta lamps; a variety of terracotta offering vessels, including about 100 unguent –bottles; 12 marble ash urns and 2 children’s sarcophagi; and more than 150 epitaphs, many of them in pieces intrigued b the prospect of ‘rediscovering’ this collection, I set out to learn as much as possible about its provenance. Documents in the Registrar’s office at the museum and photographs (Kodaks) taken by Ballard-Thruston in 1911 and 1912-document important details bout the purchase and the site in Rome from which the artifacts came. My research in Rome and at various museums in the US has reveals that the monuments in the Speed constitute the largest American collection of Roman funerary artifacts with a documented provenance.

Not surprising, the epitaphs in the Ballard-Thurston Collection indicate that most of the men and women buried in the via Salaria tombs were of slave or freed status; there are also several epitaphs identifying children and young adults. The inscriptions typically give the name, age, social status, and occasionally the occupation, of the deceased, as well as the name of the loved one’s who paid for the memorial. Among the more interesting epitaphs are those of L. Livineius Eutactus, a painter, and Blastus, who was probably the slave overseer of an estate (vilicus). There are also epitaphs identifying a nurse (mamma) and soldiers in the Praetorian Guard.

Given the size and variety of this collection, the decision was made to focus first on the publication of the epitaphs-the largest body of material. Professor George Houston, an expert in Latin epigraphy from the University of North Carolina at Chapel Hill and I are collaborating on a project to research and catalogue the inscriptions our goal is to produce an on-line catalogue of the epitaphs, to be accessed from the websites of both the Speed Museum and the University of Louisville. It will consist of high quality images of the stones, transcriptions and translations of the inscriptions, and bibliographic citations; there will also be links to information bout related aspects of Roman culture, such as burial customs, family life, and the roman army. It is our intention that this site should be a useful resource for both scholars and students.

With the assistance of 4 students at the University of Louisville, the support of the Speed Museum, and the generosity of the college of Arts and sciences, more than 135 epitaphs have been catalogued and digitally photographed this academic year. A grant proposal will shortly be submitted to the preservation and Access Division for the National Endowment for the Humanities to fund the research and production of the on-line catalogue; Professor Houston and I envision that this project will take bout 2 years.

The publication of the epitaphs in the Ballard-Thurston Collection, and it related interactive site on Roman culture, will be an important resource of epigraphers and historians, as well as Latin students in high schools and universities. The on-line catalogue will also make a significant contribution to the scholarship in the fields of roman funerary art and archaeology, as well as the history of the acquisition of antiquities in American museums. While we cannot determine the cause of death of the men, women, and children whose epitaphs we are studying, these inscriptions reveal fascination information bout the families and occupations of Rome’s working classes. This project reminds us of the reality of these people whose voices we can barely hear